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PHTY314 > Week One > Flashcards

Week One Flashcards

0
Q

Why is clinical reason important

A 
Improves diagnostic accuracy 
Informs treatment 
Leads to improved patient care
Improves therapist satisfaction 
Increases accountability
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1
Q

What is clinical reasoning

A

A process via which the therapist, in conjunction with the patient and relevant others, structures evaluation and management strategies

Involves problem solving, clinical decision making and negotiation

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2
Q

Hypothetico-deductive method (doctors) vs BPS model

A

BPS model focuses on synthesis of assessment findings, overall treatment planning and achievement of outcomes with a focus on client-centred practice

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3
Q

What is the flat affect

A

They don’t engage in normal conversation

- usually a sign of depression

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4
Q

Neurological impairments

A

Motor - tone, muscle performance, fatiguability, dexterity, strength
Sensation - LT, pain, pressure, temp, proprioception
Vision
Speech
Cognition/perception
Coordination

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5
Q

SOAP

A

S - gather information, listen, notes, talking
O - observation, measurement, documentation
A - patient’s goals, impairments, activity limitations, participation restrictions, prioritise treatment plan
P - prioritise problem list, goals, motivators, evidence

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6
Q

What are the three aspects of practice-based evidence

A

Patient preference
Clinical knowledge
Best practice/evidence

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7
Q

Current principles of treatment - dragon slide

A

Harness neuroplasticity
Commence rehab immediately
Minimise use of aids in early recovery
Team approach
Detailed assessment/analysis using outcome measures
Promotors recovery of normal movement patterns/techniques
Task-specific (functional) practice
Maximise practise opportunities
Prevent secondary changes - pressure lesions etc
Practise must be sufficiently challenging to promote learning
Aim for family/community integration

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8
Q

What is neuroplasticity

A

The ability of neurons to rearrange their anatomical and functional connectivity in response to environmental inputs
Regenerative sprouting, synaptogenesis and synaptic remodelling

Affected by activity and behaviour - therefore VERY important

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9
Q

Why is early commencement so important

A

Post brain injury the CNS starts to re-organise within the first few hours
Ensure any neural changes facilitate return of normal function rather than abnormal function/poor adaptive strategies
Rehab must commence immediately

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10
Q

What is collaborative goal setting

A

Patient-centred treatment = prioritising the client’s goals and setting gaols with the client, family and carers
To maximise learning, all practice throughout the day should be consistent
- neuroplasticity - all movements have to be the same in order to remember

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11
Q

Why measure outcome

A

Guide to treatment planning and prioritisation
Document change over time (clinical progress, achievement of institutional goals, financials accountability)
Examine efficacy of clinical care
Assist motivation of patient +/- therapist
Provide an indicator of need to modify Rx
Assist prognostication - be careful with this, don’t say they can’t recover when they can

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12
Q

Why do we need to minimise the use of aids in early recovery

A

Use of aids is not normal
Introducing an aid will immediately alter the learning environment, biomechanics, joint ROM, patterns of muscle firing, overall motor (re)-learning

When the nervous system is damaged quality of learning and skill acquisition is vital for maximising recovery - linked to neuroplasticity

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13
Q

Why is the promotion of normal movement patterns so important

A

Normal may not be achievable - aim for recovery

Minimise compensatory patterns

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14
Q

How can we prevent secondary changes

A

Maintain joint flexibility and muscle length - decrease contracture
Address functional strength issues
Avoid practice of inefficient adoptive strategies, learned non-use and promote functional moment
Prevent over-stimulation of exaggerated reactions

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15
Q

Optimising recovery

A

Motivation
Maximise activity time
Involve family, staff etc
Rehab should occur throughout the day
Remove barriers to participation
Sufficiently repetitive, challenging and task specific training
Consider the impact other factors may have on learning - cognitive, visual, hearing, perceptual, emotional,social and cultural

Current trends

  • constrain induced movement
  • electrical stimulation
  • class work
  • PWSTT
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16
Q

What is incharge of initiating moment

A

The primary motor cortex

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17
Q

Parietal lobe

A

Integrate sensory knowledge

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18
Q

Temporal lobe

A

Memory and hearing

19
Q

Occipital lobe

A

Visual perception

20
Q

Frontal lobe

A

Personality, conscious thought

21
Q

What are the ascending pathways

A

Spinothalamic - temperature and pain
Dorsal columns - light touch
Spinocerebellar - muscles and their tone

22
Q

What receptors pick up

  • temperature
  • light tough/deep pressure
  • proprioception
  • discrimination
A

Temp = thermoreceptors
Light touch = Meissner’s corpuscles
Proprioception = spindles, GTO’s, Ruffini corpuscles
Discrimination = Pacinian corpuscles, Merkel’s discs

23
Q

What are the four fibre types in the spinal cord cells

A

General somatic afferent (sensory) - information from the body
General somatic efferent (motor) - information to the body
General visceral afferent (sensory) - information from the viscera
General visceral efferent (motor) - information to the viscera

24
Q

What are the descending motor pathways (efferent)

A

Corticospinal - precise voluntary
Tectospinal - head and eye movements
Rubrospinal - red nucleus, flexor activity
Vestibulospinal - balance, angular and liner acceleration, extensor messages
Reticulospinal - extension against gravity

25
Q

What is the role of the internal capsule

A

So sensory information can be integrated
Close to the thalmus - everything passes through it, either in or out of it, expect smell which goes to the olfactory bulbs in the limbic system

26
Q

What is the role of the basal ganglia

A

Provides connections between the thalamus and cortex
Complex process of inhibition of inhibitory pathways in the motor areas, therefore the BG is in charge of allowing or initiating movement
It is in charge of amplitude and velocity of movement
Attached closely to the limbic system
Initiation of movement and ability to continue movement
Multitasking
Parkinson’s is due to a lack of BG function

27
Q

What is the role of the cerebellum

A

Vermus - centre of the cerebellum
Correction of ongoing movement
Coordinating and comparing movement all the time
Judging timing and sequencing to be at the ball when it lands

Contains the most neurons
Coordinates all sensory information and acts as a comparator between actual and intended movement
Maintains muscle tone and dynamic postural control
Hand-eye coordination

28
Q

Purkinje cells

A

Found in cerebellar cortex and receive electrochemical impulses from other cells
They are classified as inhibitory as they release GABA, responsible for inhibiting or reducing the firing rate of neurons

29
Q

Blood supply of the brain

A

Carotid - most of cerebral cortex = anterior and middle cerebral arteries
Vertebro-basilar - brainstem, cerebellum and posterior cerebral artery

30
Q

What is the pathway of the peripheral nerves

A

LMN - final common pathway

Form anterior horn cell (polio) via alpha motor neuron (injury) go neuromuscular junction/motor endplate (ALM)

31
Q

What is the Broca and Wernicke aspects of the brain

A

Broca - motor aspects of speech, tongue and making the words

Wernicke - understanding speech

32
Q

What is Broadman’s map

A

Stated that there were specific points on the brain that couldn’t be moved, this was wrong

33
Q

Hippocampus and memory - what are the 3 aspects of memory

A
  1. Procedural
    Automated motor skills and programs
    Widespread
  2. Short term
    Temporary, limited, requires rehearsal, each system has a temporary storage area
  3. Long term
    More permanent, greater capacity, no rehearsal, committing memory to long term is consolidation - HC is very important for this

Lesions result in no new LTMs, temporal lobe is the key sight for storage of LTM

34
Q

What are the four aspects of the limbic system

A 
HOME
Homeostasis 
Olfactory 
Memory 
Emotion

Concerned with

  • olfaction
  • emotions important for survival
  • visceral responses to these emotions
  • homeostasis or drive related actives important for survival (feeding, defense and sex)
  • memory
35
Q

What does the limbic system do

A

Attaching a value to the important of a behaviour
- these behaviours are drive-related activities, they are important for survival e.g. Hunger drives you to find food, flight or fight when your territory is threatened
The value attached to a behaviour is termed an emotion

36
Q

What is the role of the thalamus

A

Major role in producing an emotional response to needs signalled by hunger, thirst etc
Maintains homeostasis
Sensory inputs that arouse emotion also initiate autonomic responses

37
Q

What a re the three levels of planning that occur before any action

A
  1. Executive planning - kinematic condones and motivation
  2. Motor preparation - SMA, BG, Ce
  3. Movement execution - central = primary cortex, peripheral = LMN, NMJ and muscle
38
Q

What are is me neurological impairments contributing to abnormal movement

A 
Reduced tone
Weakness
Reduced sensation/proprioception 
Reduced vision 
Reduced coordination 
Vestibular 
Perception 
Dexterity (tone)
Speech
39
Q

What are self-protective behaviours

A

Strategies to implement when assisting patients, which helps to protect our backs/body
Remaining conscious about spine and body

40
Q

What is ergomotricity

A

Proper use of equipment to ensure we get the most energy saving/safe use out of it

41
Q

What are the essential components of rolling over

A 
Supine 
Neck rotation to direction 
Shoulder abduction 
Upper arm - shoulder protraction, horizontal adduction and polvo extension 
Segmental rotation of trunk 
Hip and knee flexion 
Hip adduction 
Stability on side lying
42
Q

What are some adaptive strategies that patients may use if they can’t roll

A

Moving affected leg/arm with unaffected side
Lifting up/using bar to pull themselves up and over
Pulling themselves over

43
Q

How can we make it easier for out patient to roll

A

Remove friction with slide sheet

Remove/eliminate gravity

44
Q

Essential components of bridging

A

Supine
Hip and knee flexion to crook lying
Stabilise feet hip extension with trunk stability
Coordination at the knee to stabilise

45
Q

Essential components for bridging and shifting to the edge of the bed

A 
Hip and knee flexion a nd adduction 
Hip extension 
Trunk side flexion 
Neck flexion and trunk flexion 
Reaching with UL
Side flexion to shift to side
46
Q

Essential components of lying to sitting

A 
Side neck flexion 
Shoulder abduction, elbow extension 
Upper arm - shoulder protraction, horizontal adduction, polvo extension 
Trunk side flexion
Hip and knee flexion 
Knee extension 
Hip/weight comes over 
Stability in sitting

PHTY314 (5 decks)

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